How To Use CPT Code 43130

CPT 43130 describes the surgical procedure known as diverticulectomy of the hypopharynx or esophagus, which involves the removal of a diverticulum from these areas. This article will provide an overview of CPT code 43130, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of when to use this code.

1. What is CPT Code 43130?

CPT 43130 is a code used to describe the surgical procedure known as diverticulectomy. Specifically, it refers to the removal of a diverticulum from the hypopharynx or esophagus through a cervical approach. This procedure may or may not involve myotomy, which is the cutting of muscle. It is important to note that diverticula are abnormal pouches or sacs that can develop in various hollow organs, such as the intestines, bladder, esophagus, or others.

2. Official Description

The official description of CPT code 43130 is: ‘Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach.’ This description indicates that the procedure involves the removal of a diverticulum from the hypopharynx or esophagus, and it can include myotomy if necessary. The approach used for this procedure is through the neck, specifically the cervical region.

3. Procedure

1. When performing CPT 43130, the healthcare provider begins by preparing and anesthetizing the patient.
2. Next, the provider makes an incision in the skin of the neck to access the hypopharynx or esophagus with the diverticulum pouch.
3. If needed, the provider may also make an incision in the cricopharyngeus muscle, which is one of the upper esophageal sphincter closure muscles, to tighten it and prevent future formation of diverticula.
4. The diverticulum is then grasped and removed through methods such as oversewing or excision.
5. After the diverticulum is eliminated, the provider repairs the hypopharynx or esophagus in layers.
6. The site is irrigated with an antibiotic solution, and the wound is closed in layers.

4. Qualifying circumstances

CPT 43130 is performed on patients who have a diverticulum in the hypopharynx or esophagus that requires surgical removal. The procedure is typically indicated when the diverticulum causes symptoms or complications, such as difficulty swallowing, recurrent infections, or bleeding. It is important to note that the procedure is performed through a cervical approach, and it may or may not involve myotomy, depending on the specific case.

5. When to use CPT code 43130

CPT code 43130 should be used when a diverticulectomy of the hypopharynx or esophagus is performed through a cervical approach. This code is appropriate when the diverticulum is removed, with or without myotomy, and the procedure is performed specifically in the hypopharynx or esophagus. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT code 43130, the healthcare provider must document the following information:

• Patient’s diagnosis indicating the presence of a diverticulum in the hypopharynx or esophagus
• Details of the procedure, including the cervical approach, removal of the diverticulum, and any additional myotomy performed
• Specific location of the diverticulum within the hypopharynx or esophagus
• Any complications encountered during the procedure
• Layers of repair performed on the hypopharynx or esophagus
• Use of an antibiotic solution for irrigation
• Method of wound closure

7. Billing guidelines

When billing for CPT code 43130, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The procedure must involve the removal of a diverticulum from the hypopharynx or esophagus through a cervical approach. If myotomy is performed, it should be documented accordingly. It is also important to follow any additional guidelines provided by the payer or coding guidelines. It is recommended to review the specific billing guidelines for CPT code 43130 to ensure accurate reporting.

8. Historical information

CPT code 43130 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient presents with a symptomatic diverticulum in the hypopharynx, causing difficulty swallowing. The healthcare provider performs a diverticulectomy through a cervical approach, removing the diverticulum and repairing the hypopharynx.
2. A diverticulum is discovered in the esophagus during a diagnostic procedure. The healthcare provider decides to perform a diverticulectomy through a cervical approach, removing the diverticulum and repairing the esophagus.
3. A patient with recurrent infections in the hypopharynx is found to have a diverticulum. The healthcare provider performs a diverticulectomy through a cervical approach, removing the diverticulum and repairing the hypopharynx to prevent further complications.